Adhesion of Endodontic Sealers to Human Root Dentine Submitted to Different Surface Treatments

Objective: To evaluate the adhesion of the endodontic sealers Epiphany, Apexit Plus, and AH Plus to root canal dentin submitted to different surface treatments, by using the push-out test. Methods: One hundred twenty-eight root cylinders obtained from maxillary canines were embedded in acrylic resin, had the canals prepared, and were randomly assigned to four groups (n = 32), according to root dentin treatment: (I) distilled water (control), (II) 17% EDTAC, (III) 1% NaOCl and (IV) Er:YAG laser with 16-Hz, 400-mJ input (240-mJ output) and 0.32-J/cm(2) energy density. Each group was divided into four subgroups (n = 8) filled with Epiphany (either dispensed from the automix syringe supplied by the manufacturer or prepared by hand mixing), Apexit Plus, or AH Plus. Data (MPa) were analyzed by ANOVA and Tukey's test. Results: A statistically significant difference (p < 0.01) was found among the root-canal sealers, except for the Epiphany subgroups, which had statistically similar results to each other (p > 0.01): AH Plus (4.77 +/- 0.85), Epiphany/hand mixed (3.06 +/- 1.34), Epiphany/automix syringe (2.68 +/- 1.35), and Apexit Plus (1.22 +/- 0.33). A significant difference (p < 0.01) was found among the dentin surface treatments. The highest adhesion values were obtained with AH Plus when root dentin was treated with Er: YAG laser and 17% EDTAC. Epiphany sealer presented the lowest adhesion values to root dentin treated with 17% EDTAC. Conclusions: The resin-based sealers had different adhesive behaviors, depending on the treatment of root canal walls. The mode of preparation of Epiphany (automix syringe or hand mixing) did not influence sealer adhesion to root dentin.

Real-time Polymerase Chain Reaction Quantification of Porphyromonas gingivalis and Tannerella forsythia in Primary Endodontic Infections

Introduction: Porphyromonas gingivalis and Tannerella forsythia are anaerobic bacteria commonly involved in root canal infections. Although previous investigations have assessed these species by strictly qualitative approaches, accurate determination of their cell levels by a sensitive quantitative technique may contribute with additional information regarding relevance in pain of endodontic origin. Method: The root canal levels of P gingivalis, T forsythia, and total bacteria were investigated by a quantitative polymerase chain reaction (PCR) assay based on unique copy molecular markers. A total of 32 symptomatic (n = 14) and asymptomatic (n = 18) cases of endodontic infections were analyzed. Root canal samples were collected; genomic DNA was extracted and submitted to SYBR Green I real-time PCR targeting the rgpB (P gingivalis), bspA (T forsythia), and rpoB (total bacteria) single copy genes. Results: Overall, R gingivalis, T forsythia, and the coexistence of both species were encountered in 28%, 66%, and 22% of the subjects, respectively. P gingivalis and T forsythia levels ranged from 5.65 x 10(-6) to 1.20 x 10(-2) and from 5.76 x 10(-6) to 1.35 x 10(-1). T forsythia was highly prevalent and numerous in the study groups, whereas P gingivalis was moderately frequent and less abundant, displaying 19-fold lower average levels than the former. Conclusions: The endodontic levels of P gingivalis and T forsythia, individually or in conjunction, did not display significant associations with the manifestation of pain of endodontic origin. (J Endod 2009,35:1518-1524)

Vertical Root Fracture in Upper Premolars with Endodontic Posts: Finite Element Analysis

Upper premolars restored with endodontic posts present a high incidence of vertical root fracture (VRF). Two hypotheses were tested: (1) the smaller mesiodistal diameter favors stress concentration in the root and (2) the lack of an effective bonding between root and post increases the risk of VRF. Using finite element analysis, maximum principal stress was analyzed in 3-dimensional intact upper second premolar models. From the intact models, new models were built including endodontic posts of different elastic modulus (E = 37 or E = 200 GPa) with circular or oval cross-section, either bonded or nonbonded to circular or oval cross-section root canals. The first hypothesis was partially confirmed because the conditions involving nonbonded, low-modulus posts showed lower tensile stress for oval canals compared to circular canals. Tensile stress peaks for the nonbonded models were approximately three times higher than for the bonded or intact models, therefore confirming the second hypothesis. (J Endod 2009;35:117-120)

Antibacterial efficacy of endodontic irrigating solutions and their combinations in root canals contaminated with Enterococcus faecalis

Objective. The objective of this study was to evaluate the antibacterial efficacy of irrigating solutions and their combinations against Enterococcus faecalis. Study design. One hundred ten single-rooted human teeth were inoculated with E. faecalis and incubated for 21 days. Teeth were divided according to the irrigant: Group I (GI), 2.5% sodium hypochlorite solution (NaOCl); GII, 2.5% NaOCl + 10% citric acid; GIII, 2.5% NaOCl + apple cider vinegar; GIV, apple cider vinegar; GV, 2% chlorhexidine solution; GVI, 1% peracetic acid; GVII, saline solution. Microbiological samples were taken after root canal preparation and 7 days later. Data were submitted to ANOVA (5%). Results. All solutions promoted reduction of E. faecalis after instrumentation, but bacterial counts were higher in the final sample. GI, GV, and GVI had lower bacterial counts than the other groups. Conclusions. The irrigating solutions may present activity but do not eradicate E. faecalis in the root canal system. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112:396-400)

Evaluation of the flow rate of 3 endodontic sealers: Sealer 26, AH Plus, and MTA Obtura

Objective. The aim of this study was to evaluate the flow rate of 3 endodontic sealers: Sealer 26, AH Plus, and MTA Obtura. Study design. According to the method proposed by the American Dental Association (ADA specification no. 57), the sealers were placed between 2 glass slabs under a weight of 120 g. The diameters of the formed discs were measured with a digital paquimeter. The test was repeated 5 times for each sealer. Results. The results were expressed as arithmetic means, and the statistical analysis was performed through Tukey test. AH Plus showed significantly superior flow rate compared with Sealer 26 and MTA Obtura. There was no statistically significant difference between flow rates presented by Sealer 26 and MTA Obtura. Conclusion. Within the limitations of this in vitro study, it was concluded that all of the the endodontic sealers tested presented greater flow than the minimum recommended in the ADA 57 specification. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e47-e49)

Depth and percentage of penetration of endodontic sealers into dentinal tubules after root canal obturation using a lateral compaction technique: A confocal laser scanning microscopy study

Objective. The aim was to compare the percentage and depth of sealer penetration into dentinal tubules during obturation using Sealer 26, GuttaFlow, or Sealapex in root canals filled with the lateral compaction technique. Study design. Thirty root canals filled with the lateral compaction technique using GuttaFlow (n = 10), Sealapex (n = 10), or Sealer 26 (n = 10) were analyzed using confocal microscopy. The teeth were sectioned at 3 and 5 mm from the apex, and statistical analyses was performed using analysis of variance-Tukey test (P < .05). Results. Sealapex showed the deepest sealer penetration at both levels evaluated (P < .05). No statistically significance was found between Sealer 26 and GuttaFlow at the 3 mm and 5 mm levels. No statistical significance was found in the percentage of penetration around the root canal wall among the 3 sealers evaluated at both levels. Conclusions. Although Sealapex displayed deeper penetration into the dentinal tubules there was no difference in the percentage of adaptation to the root canal walls among the 3 sealers evaluated. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: 450-457)

Bacterial leakage evaluation of root canals filled with different endodontic sealers

Objective. The objective of this study was to evaluate the sealing ability of AH Plus, Epiphany, Acroseal, Endofill, and Polifil after active lateral condensation technique, by using a bacterial test, during 64 days. Study design. One hundred bovine incisors were cleaned and shaped; then they were filled with the endodontic sealers and adapted into a microcentrifuge tube. The setup root/microcentrifuge tube was added to glass flasks containing Brain Heart Infusion broth. A culture of Enterococcus faecalis was inserted into the upper chamber of each assembly. Daily leakage was evaluated through the broth turbidity. Results. The results were submitted to statistical analysis (Kaplan-Meier method, Kruskal-Wallis and Dunn tests). Conclusions. AH Plus and Endofill had the worst sealing ability when compared with Polifil, which showed the least leakage. Acroseal and Epiphany showed a tendency toward having an intermediate behavior; however, there was no significant difference among Acroseal, Epiphany, and the other sealers. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: e56-e60)

Post space cleaning using a new nickel titanium endodontic drill combined with different cleaning regimens

This study compared the effect of two drills and five cleaning regimens on post space debridement. One hundred extracted premolars were instrumented and obturated with warm vertical compaction of gutta percha. The teeth were divided into two groups according to the drill used to remove gutta percha/sealer and for post space preparation: a Largo drill (Largo; Dentsply, St Quentin en Yvelines, France) or a MTwo-PF drill (Sweden&Martina, Due Carrare, Padova, Italy). The following cleaning regimens were used: EDTA, ultrasonics, ultrasonics + EDTA, phosphoric acid, and distilled water. Scanning electron microscopic images of the post spaces were taken, and the presence of debris and of open dentin tubules were evaluated. The ultrasonics + EDTA, phosphoric acid, and EDTA groups were comparable in open tubules scores for both drills and in debris scores after the use of MTwo-PF (p > 0.05). The ultrasonics and control groups performed significantly worse (p < 0.05). The MTwo-PF drill resulted as effective as the Largo drill in obtaining a good post space cleaning, especially when followed by ultrasonics + EDTA irrigant regimen.

Apical limit of root canal filling and its relationship with success on endodontic treatment of a mandibular molar: 11-year follow-up

Objective. This article discusses the relationship between apical limit of root canal filling and success on endodontic treatment of a mandibular molar. Study design. A mandibular right first molar with vital pulp was endodontically treated, and 3 years later periapical lesions on mesial and distal roots were detected. The canals were retreated and obturated to the same levels as in the previous treatment. Results. An 8-year radiographic follow-up showed repair of the periapical lesions on both roots. Conclusions. Results suggest that the apical limit of obturation seems to have no influence in the repair of periapical tissues in mandibular molars. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112: e48-e50)

Solubility of Epiphany Endodontic Sealer Prepared with Resinous Solvent

Purpose: To evaluate in vitro the solubility of the Epiphany endodontic filling material Epiphany (Pentron Clinical Technologies, Wallingford, CT) prepared with its resinous solvent. Methods: The specimens were prepared in the following experimental conditions: (1) GI, epiphany without photoactivation; (2) GII, Epiphany prepared with resinous solvent without photoactivation; (3) Gill, Epiphany followed by photoactivation; and (4) GIV, Epiphany prepared with resinous solvent followed by photoactivation. Ten specimens of each group were obtained from Teflon molds with 80% reduction in volume of the specimen`s dimensions based on American National Standard Institute/American Dental Association (ANSI/ADA) Specification No. 57. The samples were weighted and immersed in distilled water for 7 days. After this period, they were removed, dried, and weighed again. Solubility was calculated by using samples weight loss (%). The immersion liquid was evaluated through atomic absorption spectrometry. Results: The sealers without photoactivation were statistically similar (p > 0.05) between themselves (GI = 6.93% and GII = 6.39%) and different from the uncured sealers, which were statistically different between themselves (p < 0.05) (GIII = 3.56% and GIV = 0.47%). Only the Epiphany sealer prepared with resinous solvent followed by photoactivation presented solubility values within ANSI/ADA requirements, liberating the following amounts of ions: 114.43 mu g of Ca(2+)/mL, 2.4 mu g of Mg(2+)/mL, 0.33 mu g of Fe(2+)/mL, 0.11 mu 4g of Zn(2+)/mL, 1.31 mu g of Ni(2+)/mL, and 7.1 mu g of Na(+)/mL. Conclusion: The association of resinous solvent to the Epiphany sealer followed by photoactivation resulted in a filling material with low solubility and expressive liberation of calcium ions. (J Endod 2009;35:715-718)

Diagnosis and treatment of odontogenic cutaneous sinus tracts of endodontic origin: three case studies

To describe three cases of extraoral sinus tracts, related to infected teeth, which were initially misdiagnosed as skin lesions and inappropriately treated. The extraoral sinus tracts were initially misdiagnosed as skin lesions. Dermatological surgery was performed and antibiotics prescribed but the lesions did not resolve. Then, a dental cause was sought, and identified. Endodontic intervention resulted in resolution of the problem, confirming the initial misdiagnosis. center dot Dermatologists and other medical practitioners should be aware that dental extraoral sinus tracts can be confused with skin lesions. center dot A dental aetiology, as part of a differential diagnosis, should be kept in mind with oro-facial skin lesions. center dot If an extraoral sinus tract is of endodontic origin, then elimination of infection through effective endodontic treatment will lead to resolution of the sinus tract. center dot Early correct diagnosis can prevent unnecessary and ineffective antibiotic therapy and/or surgical intervention.

Influence of endodontic sealers on the bond strength of carbon fiber posts

Objective: The aim of this study was to verify the influence of endodontic sealers on the bond strength of an adhesive system and a resin cement used for carbon posts cementation. Methods: Thirty extracted human premolars were instrumented and randomly divided into three groups according to the tested sealer: EndoFill, Sealapex, or EndoREZ. Specimens were stored at 37 degrees C. After 48 h, half of specimens were prepared to receive the post and the others after 7 days. The posts were cemented with Adper Single Bond/Rely X ARC and stored in distilled water at 37 degrees C for 7 days. After this period, the specimens were sectioned in three slices (coronal, middle, and apical). The push-out test was performed in a universal machine and the debonded area was examined in a stereomicroscope. Results: Data were submitted ANOVA and Tukey test (alpha = 0.05). The EndoFill showed lower bond strength than other sealers (p < 0.01). The EndoREZ sealer was statistically greater than other groups for coronal and middle portions and similar for apical portion (P > 0.05). Coronal and middle portions showed the best results for all groups, mainly when the canal preparation was performed after 48 h (p < 0.01). Mixed failure occurs with more frequency (55.6%) followed by failure in adhesive-dentin interface (34.4%) and adhesive-post interface (10.0%). Conclusion: The use of EndoREZ sealer promoted higher bond strength in root coronal and middle portions when carbon post was fixed with a resin cement. (C) 2007 Wiley Periodicals, Inc.

Influence of different endodontic filling materials on root fracture susceptibility

Objective: To evaluate the influence of different endodontic materials on root fracture susceptibility. Methods: Seventy-two mandibular incisors were sectioned 1 mm below the cementoenamel junction to obtain roots of 12 mm length. Roots were submitted to chemomechanical preparation with the rotary instruments of Profile system. The obturation of root canals were performed with the following filling materials (n = 12): GI, unfilled teeth (control); GII, Endofill + gutta-percha; GIII, Sealer 26 + gutta-percha; GIV, AH Plus + gutta-percha; GV, Epiphany + gutta-percha; GVI, Epiphany + Resilon. After the sealers setting time, each root was embedded in acrylic resin. The specimens were then submitted to fracture resistance test using an Instron testing machine at 1 mm/min. Results: The ANOVA test showed no significant statistical difference (p > .05) among GI (162.16 +/- 41.4N), GII (168.46 +/- 37.5N), GIII (164.83 +/- 35.7N), GIV (168.29 +/- 38.7N), GV (172.36 +/- 20.6N) and GVI (193.11 +/- 42.8N). Conclusion: The core materials (gutta-percha or Resilon) combined with the tested endodontic sealers are not able to increase the root fracture resistance in canals submitted to chemomechanical preparation. (c) 2007 Elsevier Ltd. All rights reserved.

Endodontic sequelae of dental erosion

Background. The incidence of, pulp involvement in patients with excessive wear has not been extensively documented. Methods: Clinical, records of 448 patients with excessive tooth wear were reviewed and 52 cases (11.6 per cent) with near or frank pulp exposures or root canal treatments were found and their numbers and sites were tabulated. Light microscopy of study models was used to determine aetiology at each site of exposure as. attrition, erosion or abrasion, scanning electron microscopy (SEM) was performed on some individual teeth. Results: Forty sites of near exposure and 57 sites of frank exposures or root canal treatments were found, some cases had both types of exposure. The commonest sites exposed by erosion were the palatal surfaces of maxillary, and the incisal surfaces of mandibular anterior teeth. Posterior teeth were not commonly affected. Toothbrush abrasion had exacerbated softie lesions as shown by SEM. Conclusions: Endodontic sequelae were found in 11 per cent of tooth wear patients as late stages of dental erosion. Near and frank exposures of the pulp thus constitute a small but significant, problem for,the Australian dental profession's concern in the of the tooth wear cases.

Fatigue life assessment of endodontic instruments subjected to multi planar curvature

This present study aimed to investigate the fatigue life of unused (new) endodontic instruments made of NiTi with control memory by Coltene™ and subjected to the multi curvature of a mandibular first molar root canal. Additionally, the instrument‟s structural behaviour was analysed through non-linear finite element analysis (FEA). The fatigue life of twelve Hyflex™ CM files was assessed while were forced to adopt a stance with multiple radius of curvature, similar to the ones usually found in a mandibular first molar root canal; nine of them were subjected to Pecking motion, a relative movement of axial type. To achieve this, it was designed an experimental setup with the aim of timing the instruments until fracture while worked inside a stainless steel mandibular first molar model with relative axial motion to simulate the pecking motion. Additionally, the model‟s root canal multi-curvature was confirmed by radiography. The non-linear finite element analysis was conducted using the computer aided design software package SolidWorks™ Simulation, in order to define the imposed displacement required by the FEA, it was necessary to model an endodontic instrument with simplified geometry using SolidWorks™ and subsequently analyse the geometry of the root canal CAD model. The experimental results shown that the instruments subjected to pecking motion displayed higher fatigue life values and higher lengths of fractured tips than those with only rotational relative movement. The finite element non-linear analyses shown, for identical conditions, maximum values for the first principal stress lower than the yield strength of the material and those were located in similar positions to the instrument‟s fracture location determined by the experimental testing results.